Choledochal cyst in children can increase the risk of bile duct obstruction and infection! Minimally invasive surgery has numerous advantages
A newborn baby was found to have a common bile duct cyst through ultrasound examination before birth, so he was transferred to the hospital for further examination. It was diagnosed as type IV biliary cyst through ultrasonography and computed tomography. Since the patient currently has no symptoms, After discussion with the pediatric surgeon, the patient was discharged from the hospital and returned for surgery after 6 months. Generally, infants and young children without any symptoms can be carefully observed for up to 6 months before undergoing surgery. However, if the following conditions are present, such as abdominal pain, abnormal liver function, jaundice, or persistent enlargement of the common bile duct cyst, surgery is needed as soon as possible, regardless of age.
The liver is the second largest organ in the human body. It is located in the abdominal cavity, below the diaphragm and above the stomach and intestines. In addition to producing bile that helps the intestines digest food, the liver also helps the body in many ways: including producing clotting factors to allow blood to clot normally; proteins that carry oxygen and support the immune system, store extra nutrients, cleanse the blood of harmful substances, and control blood sugar and cholesterol levels.
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A normal liver produces bile to help digest food, but when a child has a common bile duct cyst (swelling of the common bile duct), bile can back up into the liver, causing liver problems or inflammation of the pancreas because it blocks its passage . from the pancreas to the intestine. Children with cysts of the common bile duct, the main duct of the duct, are more likely to develop bile duct cancer as adults, and early treatment can reduce these risks.
What are the causes of common bile duct cyst?
A common bile duct cyst is a congenital or acquired disease that slows the flow of bile from the liver to the small intestine, causing the biliary system to “regress” and causing a variety of health problems. Most common bile duct cysts (about two-thirds) are diagnosed before children are 10 years old. In developed countries, the incidence of common bile duct cyst is approximately one in 100,000 to 150,000, and it is four times more common in girls than boys. The prevalence of common bile duct cyst is higher in East Asia. , the incidence rate in Japan is one in 1,000.
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The congenital cause is that there are fewer ganglion cells in the distal common bile duct in patients with common bile duct cysts, resulting in proximal dilatation of the common bile duct, which is similar to the pathogenesis of achalasia and Hirschsprung’s disease. The most popular cause of acquired causes is Babbitt’s theory, which states that cysts develop from the anomalous pancreaticobiliary junction (APBJ). APBJ refers to the bile duct and pancreatic duct 1 to 2 centimeters proximal to the sphincter of Oddi. The long channels formed are not covered by the sphincter, allowing reflux and mixing of pancreatic and bile secretions, causing activation of pancreatic enzymes, causing increased pressure and, ultimately, leading to dilation of the biliary tree, inflammation, epithelial damage, dysplasia and malignant tumors.
What are the symptoms of common bile duct cyst?
Some common bile duct cysts are discovered through ultrasound tests before the baby is born. Sometimes after the baby is born, the baby’s parents or doctor may notice a mass in the upper right abdomen. Although a child is born with a common bile duct cyst, symptoms may appear in childhood and may not appear for several years. Newborns or older children may develop the following symptoms: abdominal mass, pain in the upper right abdomen, jaundice, nausea and vomiting, fever.
How is common bile duct cyst diagnosed?
Choledochal cysts are commonly diagnosed with ultrasound. In rare cases, the cyst can be diagnosed before birth with prenatal ultrasound. Other imaging tests that may be used to diagnose common bile duct cysts include computed tomography and magnetic resonance imaging. Contrast cholangiopancreatography or endoscopic retrograde cholangiopancreatography.
Types and location of common bile duct cysts
Choledochal cysts can form in the intrahepatic (intrahepatic) or extrahepatic (outside the liver) portion of the bile duct. There are five basic types of common bile duct cysts, depending on where they occur:
Type I: the most common type (80-90%) involving a cystic or fusiform dilatation of part or all of the common bile duct with normal intrahepatic ducts, Type II: isolated diverticulum protruding from the common bile duct, Type III or choledochocele : caused by dilation of the duodenal part of the common bile duct or of the junction of the pancreatic duct, type IVa: characterized by multiple dilations of the intrahepatic and extrahepatic bile ducts, type IVb: affecting only the extrahepatic bile ducts Multiple dilations, type V or Carroll: cystic dilatation of the intrahepatic bile ducts.
How is a common bile duct cyst treated?
Children with common bile duct cysts require surgical resection of a lobe of the liver if the cyst is intrahepatic or of a portion of the duct outside the liver if the cyst is extrahepatic, as well as biliary reconstruction using a segment of intestine. Minimally invasive surgery (MIS), developed in recent years, is performed through small incisions using small surgical instruments and a camera or telescope. MIS can often reduce pain, reduce scarring, and speed up recovery time. It is a form of MIS used to remove common bile duct cysts. Called laparoscopic surgery, the surgeon uses small instruments guided by a small telescope to control movements while watching them on a video screen. With this technique, children can go home within a day or two and resume normal activities more quickly than children who have undergone open surgery.
Other benefits of minimally invasive surgery include very little scarring, much less postoperative pain, and shorter hospital stays. Without surgery, children with common bile duct cysts are at ongoing risk for other problems: such as bile duct obstruction, bile duct infection, jaundice, cirrhosis, and, in adulthood, common bile duct cysts can become cancerous if left untreated.
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